EMERGENCY DEPARTMENT SCREENING FOR ECTOPIC PREGNANCY - A PROSPECTIVE US STUDY

PURPOSE: To determine the effectiveness of pelvic sonography as a scre ening test for ectopic pregnancy. MATERIALS AND METHODS: Pelvic sonogr ams were prospectively analyzed in 1,427 consecutive patients with a s erum level of the beta subunit of human chorionic gonadotropin of over 1,500 IU/L. RESULTS: Sonograms were diagnostic in 1,158 patients and indeterminate in 269. When indeterminate studies were considered false ly negative, the diagnostic accuracy was 81%. Twenty-four percent of p atients with indeterminate studies were subsequently proved to have ec topic pregnancy. In ectopic pregnancy (n = 103), the most common findi ng was a complex adnexal mass (specificity = 92% [P < .001]). The sens itivity and specificity of screening sonography for ectopic pregnancy were 99% and 84%, respectively. CONCLUSION: Pelvic sonography is an ef fective screening test for ectopic pregnancy. Having a one in four cha nce of harboring an ectopic pregnancy, patients with indeterminate stu dies require close follow-up. The presence of a complex adnexal mass i s a strong predictor of ectopic pregnancy.